In the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH) we demonstrated that a primary-care based program of physician training in patient-centered counseling for nutrition change, when combined with a low-cost office support program, has significant beneficial effects on physician counseling behavior and patient intake of total and saturated fat, blood LDL-C levels, and weight. Counseling training without such support did not have an effect on pt outcomes. The present proposal will extend the WATCH findings by adding to the effective intervention a systems-based approach that will ensure the appropriate and timely delivery of cost-effective nutrition-intervention services. This approach will include a Systems-Based Lipid Management Program to include patient tracking, dietitian-implemented telephone counselling and guideline-driven recommendations, and the provision of videotapes and monthly newsletters to the patients. We will also utilize an innovative group nutrition intervention program (GNI); The primary outcomes which will be elevated are the following: 1. changes in study pts' eating practices (percent of calories from saturated fat); and 2. changes in study pts' blood LDL-C levels. The study population will be 1200 adults of both sexes with LDL-C levels in the highest quartile, attending the primary care clinics of the University of Massachusetts Medical Center. In this randomized controlled trial of the physicians will receive the effective WATCH program. Half of the study pts will receive the systems-based intervention. Endpoint measurements will be made at 12 months. We will asses pt dietary changes (percent of calories from saturated fat) using 24 hour telephone recalls and 7 day diet recalls, and blood LDL-C changes by lipid profile measurement. Pt demographic and psychosocial variables will be assessed by self-administrated surveys. We also will measure physician attitudes and practices; assess individual-level response to the GNI; measure pt knowledge, attitudes and behaviors related to diet modification; and assess the cost and cost-effectiveness of the delivered intervention.